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<br />NPS Form 10-900 OMB No. 1024-0018 <br />1 <br /> <br />United States Department of the Interior <br />National Park Service <br />National Register of Historic Places Registration Form <br /> <br />This form is for use in nominating or requesting determinations for individual properties and districts. See instructions in National Register <br />Bulletin, How to Complete the National Register of Historic Places Registration Form. If any item does not apply to the property being <br />documented, enter "N/A" for "not applicable." For functions, architectural classification, materials, and areas of significance, enter only <br />categories and subcategories from the instructions. <br /> <br />1. Name of Property <br />Historic name: _St. Adalbert Church (Roman Catholic)______________ <br />Other names/site number: ______________________________________ <br /> Name of related multiple property listing: <br /> ___________________________________________________________ <br /> (Enter "N/A" if property is not part of a multiple property listing <br />____________________________________________________________________________ <br />2. Location <br />Street & number: _2505 W Grace St.____________________________________________ <br />City or town: _South Bend_ State: IN________ County: _St. Joseph____ <br />Not For Publication: Vicinity: <br />____________________________________________________________________________ <br />3. State/Federal Agency Certification <br />As the designated authority under the National Historic Preservation Act, as amended, <br />I hereby certify that this nomination ___ request for determination of eligibility meets <br />the documentation standards for registering properties in the National Register of Historic <br />Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. <br />In my opinion, the property ___ meets ___ does not meet the National Register Criteria. I <br />recommend that this property be considered significant at the following <br />level(s) of significance: <br /> ___national ___statewide ___local <br /> Applicable National Register Criteria: <br />___A ___B ___C ___D <br /> <br /> <br /> <br />Signature of certifying official/Title: Date <br />Indiana DNR-Division of Historic Preservation and Archaeology <br />State or Federal agency/bureau or Tribal Government <br /> <br /> <br />